Clinical study on the application of glucocorticoids in patients with coronavirus disease 2019_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 CHEN Qing ¹ , FANG Zhongjie ² , YANG Meiying ² , HANG Xiaobo ³ , HUANG Rengang ⁴ , ZHOU Yutian ⁵ , ZHU Jiang ¹ , DENG Lei ⁶ , LIU Ying ⁷ , WEI Yan ⁷ , YU Yi ⁸ , ZHANG Chuantao ⁹ , LI Duo ¹⁰

1. Department of Respiratory and Critical Care Medicine, Sichuan Academy of Medical Sciences Hospital Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P. R. China;
2. Department of Respiratory Medicine, Wuhan Red Cross Hospital, Wuhan, Hubei 430015, P. R. China;
3. Surgical Department ICU, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P. R. China;
4. Department of Geriatric Respiratory and Critical Care Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P. R. China;
5. Infectious Department, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P. R. China;
6. Emergency Department ICU, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P. R. China;
7. Department of Respiratory Medicine, Guangyuan First People's Hospital, Guangyuan, Sichuan 628000, P. R. China;
8. Infectious Department, Guangyuan First People's Hospital, Guangyuan, Sichuan 628000, P. R. China;
9. Department of Respiratory Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P. R. China;
10. Department of Respiratory Medicine, Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

CHEN Qing, Email: cqxxc@163.com

Keywords：

Coronavirus disease 2019; Glucocorticoids; Clinical study

DOI：

10.7507/1671-6205.202005138

Video：

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Objective To investigate the clinical efficacy, side effects, influence on viral nucleic acid conversion and prognosis of glucocorticoid used in patients with coronavirus disease 2019.Methods Eighty-seven patients with severe and critical coronavirus disease 2019 were included to observe respiratory symptoms, blood oxygen saturation, pulmonary imaging absorption, weaning status, complicated bacterial infection and double infection, and prognosis after glucocorticoid use. Whether glucocorticoid use affects the patient's viral nucleic acid was analyzed.Results Of the 87 patients included, 55 were severe, 32 were critical, and 38 died, which included 30 critical patients. Seventy-seven patients accepted short-term glucocorticoid, and 10 patients accepted long-term glucocorticoid due to diffuse lung lesions and poor absorption. Eleven patients had bacterial infection and 4 cases had double infection. In 10 patients with long-term use of glucocorticoids, the lung lesions relieved, no double infection was found, but 1 patient maintained nucleic acid positive even after 5 weeks’ treatment.Conclusions The use of appropriate glucocorticoids is beneficial to the improvement of disease status and disease absorption in patients with coronavirus disease 2019. Long-term oral administration of glucocorticoids in patients with diffuse lung lesions may be beneficial to disease absorption.

Citation： CHEN Qing, FANG Zhongjie, YANG Meiying, HANG Xiaobo, HUANG Rengang, ZHOU Yutian, ZHU Jiang, DENG Lei, LIU Ying, WEI Yan, YU Yi, ZHANG Chuantao, LI Duo. Clinical study on the application of glucocorticoids in patients with coronavirus disease 2019. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(4): 235-240. doi: 10.7507/1671-6205.202005138 Copy

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31.	Hu ZL, Song C, Xu CJ, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci, 2020, 63(5): 706-711.

1. Hui DS, I Azhar E, Madani TA, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis, 2020, 91: 264-266.
2. Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet, 2020, 395: 565-574.
3. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 2020, 395: 507-513.
4. World Health Organization. Clinical management of severe acute respiratory infection when Novel coronavirus(2019-nCoV) infection is suspected: Interim Guidance[EB/OL]. [2020-01-12]. https://www.who.int/docs/default-source/coronavirus/clinical-management-of-novel-cov.Pdfsfvrsn=bc7da517_2.
5. 国家卫生健康委. 新型冠状病毒肺炎诊疗方案(试行 8 版) [EB/OL]. [2020-08-20]. http://www.gov.cn/xinwen/2020-08/20/content_5536062.htm.
6. Francesco F, Antonio V. Efficacy of synthetic glucocorticoids in COVID-19 endothelites Naunyn-Schmiedeberg's Archives of Pharmacology[EB/OL]. [2021-01]. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports.
7. Solinas C, Perra L, Aiello M, et al. A critical evaluation of glucocorticoids in the management of severe COVID-19. Cytokine Growth Factor Rev, 2020, 54: 8-23.
8. 国家卫生健康委办公厅, 国家中医药管理局办公室. 新型冠状病毒肺炎重型、危重型病例诊疗方案(试行第二版)[EB/OL]. http://www.nhc.gov.cn/yzygj/s7653p/202004/c083f2b0e7eb4036a59be419374ea89a.shtml.
9. Lu S, Zhou Q, Huang L, et al. Effectiveness and safety of glucocorticoids to treat COVID-19: a rapid review and meta-analysis. Ann Transl Med, 2020, 8(10): 627.
10. Lee KH, Yoon S, Jeong GH, et al. Efficacy of corticosteroids in patients with SARS, MERS and COVID-19: a systematic review and meta-analysis. J Clin Med, 2020, 9(8): 2392.
11. Li H, Chen C, Hu F, et al. Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis. Leukemia, 2020, 34(6): 1503-1511.
12. Pontali E, Volpi S, Signori A, et al. Efficacy of early anti-inflammatory treatment with high doses of intravenous anakinra with or without glucocorticoids in patients with severe COVID-19 pneumonia. J Allergy Clin Immunol, 2021, 147(4): 1217-1225.
13. Horby P, Mafham M, Linsell L, et al. Effect of Hydroxychloroquine in Hospitalized Patients with COVID-19: Preliminary results from a multi-centre, randomized, controlled trial[J/OL]. medRxiv. [2020-07-15]. https://doi.org/10.1101/2020.07.15.20151852.
14. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of Covid-19 - Final Report. N Engl J Med, 2020, 383(19): 1813-1826.
15. Zhou P, Yang XL, Wang XG, et al. Discovery of a novel coronavirus associated with the recent pneumonia outbreak in humans and its potential bat origin[EB/OL]. bioRxiv. [2020-01-22]. https://doi.org/10.1101/2020.01.22.914952.
16. Yan L, Xia LM. Coronavirus disease 2019 (COVID-19): role of chest CT in diagnosis and management. Am J Roentgenol, 2020, 214(6): 1280-1286.
17. 赵荣生, 杨毅恒, 杨丽, 等. 新型冠状病毒感染: 医院药学工作指导与防控策略专家共识. 中国药学杂志, 2020, 55(4): 270-277.
18. 江华, 邓洪飞, 王宇, 等. 洛匹那韦/利托那韦(LPV/r)用于 2019 新型冠状病毒肺炎的治疗可能性: 基于既往冠状病毒肺炎研究的快速系统评价. 中华急诊医学杂志, 2020, 29(2): 182-186.
19. Li N, Jie Z. The application of corticosteroids in COVID-19: a two-edged sword. J Transl Int Med, 2020, 8(2): 66-70.
20. Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in German. N Engl J Med, 2020, 382(10): 970-971.
21. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 8(5): 475-481.
22. 孟庆华, 董培玲, 郭雁宾, 等. 糖皮质激素治疗严重急性呼吸综合征初探. 中华预防医学杂志, 2003, 37(4): 233-235.
23. Xu Z, Shi L, Wang YJ, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med, 2020, 8(4): 420-422.
24. 姚小红, 李廷源, 何志承, 等. 新型冠状病毒肺炎(COVID-19)三例遗体多部位穿刺组织病理学研究. 中华病理学杂志, 2020, 49(5): 411-417.
25. Tse GM, To KF, Chan PK, et al. Pulmonary pathological features in coronavirus associated severe acute respiratory syndrome (SARS). J Clin Pathol, 2004, 57(3): 260-265.
26. Cheung OY, Chan JW, Ng CK, et al. The spectrum of pathological changes in severe acute respiratory syndrome (SARS). Histopathology, 2004, 45(2): 119-124.
27. Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med, 2003, 348(20): 1986-1994.
28. Ding Y, Wang H, Shen H, et al. The clinical pathology of severe acute respiratory syndrome (SARS): a report from China. J Pathol, 2003, 200(3): 282-289.
29. Franks TJ, Chong PY, Chui P, et al. Lung pathology of severe acute respiratory syndrome (SARS): a study of 8 autopsy cases from Singapore. Hum Pathol, 2003, 34(8): 743-748.
30. Nicholls JM, Poon LL, Lee KC, et al. Lung pathology of fatal severe acute respiratory syndrome. Lancet, 2003, 361(9371): 1773-1778.
31. Hu ZL, Song C, Xu CJ, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci, 2020, 63(5): 706-711.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical study on the application of glucocorticoids in patients with coronavirus disease 2019

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